MedWorm: Cholecystectomy

Early or Delayed Cholecystectomy for Acute Cholecystitis

Medscape Gastroenterology Headlines — Fri, 19 Mar 2010 14:39:47 +0100

This meta-analysis considers the question of whether it is better to wait until cholecystitis subsides before gallbladder surgery. Medscape General Surgery (Source: Medscape Gastroenterology Headlines)

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Are histological alterations observed in the gallbladder precancerous lesions?

Clinics — Fri, 12 Mar 2010 14:39:55 +0100

CONCLUSION: The results of this study suggest that there could be an association between some histological alterations of gallbladder and cancer, and they also suggest that the metaplasia-dysplasia-carcinoma sequence could in fact be true in the case of gallbladder cancer. Nevertheless, further studies directed towards a perfect understanding of gallbladder carcinogenesis are required. (Source: Clinics)

Transvaginal natural orifice translumenal endoscopic surgery (NOTES): a survey of women’s views on a new technique

Surgical Endoscopy — Fri, 12 Mar 2010 06:50:28 +0100

Conclusions Potentially, NOTES surgery offers women a scarless operation with the possibility of less pain than experienced in standard laparoscopic surgery. Few women, however, were troubled about the cosmetic effect of surgery. The effect of NOTES on sexual function was expressed as a particular concern by younger women. In all groups and across all ages, peritoneal access using the transvaginal route was met by significant scepticism. In Australia, women remain to be convinced about the potential advantages of the emerging NOTES technology. Content Type Journal ArticleDOI 10.1007/s00464-010-0968-3Authors Andrew D. Strickland, The Queen Elizabeth Hospital, University of Adelaide Department of Surgery Woodville Road, Woodville Adelaide SA 5011 AustraliaMichael G....

Effects of Epidural-and-General Anesthesia Combined Versus General Anesthesia Alone on Femoral Venous Flow During Laparoscopic Cholecystectomy

Journal of Laparoendoscopic — Thu, 11 Mar 2010 12:14:07 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques , Vol. 0, No. 0. (Source: Journal of Laparoendoscopic)

What Should Be Done with a Dilated Bile Duct?

Current Gastroenterology Reports — Thu, 11 Mar 2010 02:24:24 +0100

Abstract Current methods for imaging the biliary tree include ultrasound, CT, MRI, endoscopic retrograde cholangiography, and endoscopic ultrasound (EUS). Bile duct abnormalities may be identified during evaluation of patient symptoms or laboratory abnormalities, or incidentally during imaging for another problem. Biliary dilatation, when identified, may be separated into obstructive or nonobstructive causes. Clinical presentation should guide decisions on which, if any, additional investigations are necessary. Choledocholithiasis is the most common cause of obstructive dilatation and frequently requires decompression. Nonobstructive causes include cystic dilatation, aging, and possibly post-cholecystectomy state. Data are limited regarding the yield of further investigati...

Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones.

Annals of the Royal College of Surgeons of England — Wed, 10 Mar 2010 00:00:00 +0100

CONCLUSIONS A selective policy for intra operative cholangiography yields acceptably high positive results. Pre operatively asymptomatic bile duct stones rarely present following LC; thus routine imaging of the biliary tree for occult calculi can safely be avoided. Therefore a rationing approach to the use of intra operative imaging based on the pre operative indicators presented in this paper successfully identifies those patients with bile duct stones requiring exploration. Laparoscopic bile duct exploration performed by an experienced laparoscopic surgeon is a safe and effective method of clearing the bile duct of calculi with minimal complications avoiding the necessity for an additional intervention and prolonged hospital stay. PMID: 20223077 [PubMed - as supplied by publisher] (S...

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Optimal surgical technique, use of intra-operativecholangiography and management of acute gallbladder disease: the results of a nationwide survey in the UK and Ireland.

Annals of the Royal College of Surgeons of England — Wed, 10 Mar 2010 00:00:00 +0100

CONCLUSIONS A wide dissection of Calot's triangle to provide a critical view of safety is the technique most commonly recommended by AUGIS surgeons (83 percent) to minimise risk of bile duct injury, in contrast to 24 percent that recommend routine IOC. The majority (88 percent) of AUGIS surgeons advise index admission cholecystectomy for acute gallbladder disease. PMID: 20223074 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)

Licorice – or more?

Experimental and Clinical Endocrinology and Diabetes — Tue, 09 Mar 2010 14:27:37 +0100

Exp Clin Endocrinol DiabetesDOI: 10.1055/s-0029-1224123AbstractA 57 yr old man presented to endocrinology clinic with a six year history of poorly controlled hypertension which was treated with Metoprolol 200 mg/day and Enalapril 20 mg/day. He was asymptomatic but incidentally hypokalaemia was detected while having cholecystectomy, two years prior to his clinic appointment. He had never been on diuretics or laxatives. He was started on potassium supplements (120 mmol/d) and advised to increase dietary potassium by the surgical team. A detailed personal history revealed ingestion of 300–500 g licorice per day. Physical examination was unremarkable apart from increased blood pressure of 180/105 mmHg. Following the initial visit, his serum electrolyes (K+3....

Postoperative Patient Attitudes and Perceptions of Transvaginal Cholecystectomy

Journal of Laparoendoscopic — Thu, 04 Mar 2010 20:36:57 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques , Vol. 0, No. 0. (Source: Journal of Laparoendoscopic)

Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

The British Journal of Surgery — Thu, 04 Mar 2010 00:00:00 +0100

Authors: Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR The original article to which this Erratum refers was published in British Journal of Surgery 2010; 97: 141-150. PMID: 20205210 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)

Single-incision laparoscopic cholecystectomy is feasible: initial experience with 80 cases

Surgical Endoscopy — Wed, 03 Mar 2010 08:51:13 +0100

Conclusion SILS cholecystectomy is feasible, with acceptable morbidity. Although not directly compared in this study, postoperative recovery appears shorter than after standard laparoscopy, but more studies are needed. Content Type Journal ArticleDOI 10.1007/s00464-010-0943-zAuthors Chris Edwards, 14 Medical Park Dr. Asheville NC 28803 USAAlan Bradshaw, 14 Medical Park Dr. Asheville NC 28803 USAPaul Ahearne, 14 Medical Park Dr. Asheville NC 28803 USAPierre Dematos, 14 Medical Park Dr. Asheville NC 28803 USATed Humble, 14 Medical Park Dr. Asheville NC 28803 USARandy Johnson, 14 Medical Park Dr. Asheville NC 28803 USADavid Mauterer, 14 Medical Park Dr. Asheville NC 28803 USAPeeter Soosaar, 14 Medical Park Dr. Asheville NC 28803 USA Journal Surgical EndoscopyOnli...

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EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent in patients who are unsuitable for cholecystectomy: a pilot study (with video)

Gastrointestinal Endoscopy — Mon, 01 Mar 2010 00:00:00 +0100

Conclusion: EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent may be a feasible and useful alternative in patients with acute cholecystitis who are unsuitable candidates for cholecystectomy. (Source: Gastrointestinal Endoscopy)

Early Surgery Lowers Cholecystectomy Costs

Internal Medicine News — Mon, 01 Mar 2010 00:00:00 +0100

HOT SPRINGS, VA. — Delaying gallbladder surgery in elderly patients with acute cholecystitis might save money in the short run, but it racks up a bigger bill later in health outcomes and cash outlay, judging by a Medicare claims database study. (Source: Internal Medicine News)

Single-port laparoscopic repair of a Morgagni diaphragmatic hernia in a pediatric patient: advancement in single-port technology allows effective intracorporeal suturing

Journal of Pediatric Surgery — Mon, 01 Mar 2010 00:00:00 +0100

We report a case of a foramen of Morgagni hernia repaired by a single-port laparoscopic technique. A 20-month-old (10 kg) boy underwent a 97-minute procedure through a 15-mm umbilical incision and had no complications. Although other pediatric single-port case series have been reported in the literature, this case represents the first time a diaphragmatic defect has been addressed. Moreover, unlike previous experiences that involved procedures of resection (appendectomy, cholecystectomy, etc), this case required operative repair and reconstruction with intracorporeal suturing via a single-access site. Advancement in instrument and port technology makes such procedures feasible in pediatric patients. (Source: Journal of Pediatric Surgery)

Single-incision laparoscopic cholecystectomy (SILC): a refined technique

American Journal of Surgery — Mon, 01 Mar 2010 00:00:00 +0100

Conclusion: SILC or BIAS is effective for gallbladder removal, with comparable lengths of stay, operative times, and safety as the traditional method, with better cosmetic results. (Source: American Journal of Surgery)

What ring tone should be used for patient safety? Early results with a Blackberry-based telementoring safety solution

American Journal of Surgery — Mon, 01 Mar 2010 00:00:00 +0100

Conclusion: Remote guidance for laparoscopic cholecystectomy with existing technology can be accomplished with relatively low cost and minimal setup. Additional evaluation of our methods will aim to identify reliability, validity, and accuracy. Using our method, other forms of remote guidance may be feasible, such as other laparoscopic procedures, diagnostic ultrasonography, and remote intensive care unit monitoring. In addition, this method of remote guidance may be extended to centers with smaller budgets, allowing ubiquitous use of neighboring consultants and improved safety for our patients. (Source: American Journal of Surgery)

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Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy

Surgical Endoscopy — Tue, 23 Feb 2010 07:09:16 +0100

Abstract Enthusiasm for natural orifice transluminal endoscopic surgery (NOTES) has been partly tempered by the reality that most NOTES procedures to date have been laparoscopically assisted. After safely performing transvaginal cholecystectomy in an IACUC-approved porcine model, the authors embarked on an institution review board (IRB)-approved protocol for ultimate performance of pure NOTES cholecystectomy in humans. They describe their experience performing a true NOTES transvaginal cholecystectomy after safely accomplishing three laparoscopically assisted or hybrid procedures in humans. One of the patients was a 35-year-old woman presenting with symptoms of biliary colic. Ultrasound confirmed gallstones, and her liver enzymes were normal. Pneumoperitoneum to 15 mm...

Laparoscopic common bile duct exploration and holmium laser lithotripsy: a novel approach to the management of common bile duct stones

Surgical Endoscopy — Tue, 23 Feb 2010 07:09:16 +0100

Conclusions Laparoscopic CBD exploration via a transcystic approach together with holmium laser lithotripsy is a safe and effective way to clear large solitary or impacted CBD stones. This technique also avoids choledochotomy and may be used in concert with other methods such as ERCP, percutaneous cholangioscopy, and open exploration. Content Type Journal ArticleCategory VideoDOI 10.1007/s00464-009-0837-0Authors Oliver Varban, Wake Forest University Baptist Medical Center Department of General Surgery Medical Center Boulevard Winston-Salem NC 27157 USADean Assimos, Wake Forest University Baptist Medical Center Department of Urology Medical Center Boulevard Winston-Salem NC 27157 USACorey Passman, Wake Forest University Baptist Medical Center Department of Urology Me...

Magnetic retraction for NOTES transvaginal cholecystectomy

Surgical Endoscopy — Tue, 23 Feb 2010 07:09:02 +0100

Conclusions Transvaginal cholecystectomy can be completed safely using current technology. Further studies are needed to determine the safety of the procedure and to determine whether it confers any benefits other than cosmesis. Content Type Journal ArticleCategory VideoDOI 10.1007/s00464-010-0954-9Authors Santiago Horgan, University of California San Diego CA USAYoav Mintz, University of California San Diego CA USAGarth R. Jacobsen, University of California San Diego CA USABryan J. Sandler, University of California San Diego CA USAJohn P. Cullen, University of California San Diego CA USAAdam Spivack, University of California San Diego CA USADavid W. Easter, University of California San Diego CA USAAlana Chock, University of California San Diego CA USAMichelle K. Sav...

Reply to: Conversion after laparoscopic cholecystectomy in England

Surgical Endoscopy — Tue, 23 Feb 2010 07:08:28 +0100

Content Type Journal ArticleCategory Letter-ReplyDOI 10.1007/s00464-010-0933-1Authors John Slavin, Leighton Hospital Department of Surgery, Mid Cheshire Hospitals NHS Trust Middlewich Road Crewe CW1 4QJ UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Incidence, management, and outcome of incidental gallbladder carcinoma: analysis of the database of the Swiss association of laparoscopic and thoracoscopic surgery

Surgical Endoscopy — Tue, 23 Feb 2010 07:08:22 +0100

Conclusion IGBC has a low incidence (0.28%). We present a large study of patients with IGBC, comparing the overall survival by different histological findings. We observed a significant benefit for the group with pT2 and pT3. Therefore we recommend extended resection of the gallbladder bed and the regional lymph nodes for patient with incidental histologically confirmed pT2 and pT3 carcinoma of the gallbladder after performance of laparoscopic cholecystectomy. For patients with pT1b stage no recommendations can be given based on this study. Content Type Journal ArticleDOI 10.1007/s00464-010-0952-yAuthors Philippe Marc Glauser, Hospital of Liestal Department of Surgery 4410 Liestal SwitzerlandDaniel Strub, Hospital of Liestal Department of Surgery 4410 Liestal Swit...

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Gallbladder cancer: role of laparoscopy in the management of potentially resectable tumors

Surgical Endoscopy — Tue, 23 Feb 2010 07:08:19 +0100

Conclusions Laparoscopy may be employed in the management of patients with early forms of gallbladder cancer undergoing reoperation. Although the presence of adhesions may result in inadequate exploration, there is a subset of patients for whom it is possible to perform a complete exam. Furthermore, laparoscopic lymphadenectomy and gallbladder bed resection is a promising technique in well-selected patients. Content Type Journal ArticleDOI 10.1007/s00464-010-0925-1Authors Xabier de Aretxabala, Clinica Alemana Santiago Department of Surgery Av Vitacura 5951 Vitacura, Santiago ChileJorge Leon, Clinica Alemana Santiago Department of Surgery Av Vitacura 5951 Vitacura, Santiago ChileJuan Hepp, Clinica Alemana Santiago Department of Surgery Av Vitacura 5951 Vitacura, San...

A decade of washing out common bile duct stones with papillary balloon dilatation as a one-stage procedure during laparoscopic cholecystectomy

Surgical Endoscopy — Tue, 23 Feb 2010 07:07:56 +0100

Conclusions We consider the wash out of common bile duct stones after LTPBD in a one-stage procedure to be an easy to do and safe operation with great results. Cooperation with an intervention radiologist and application of an angioplastic dilatation dotter balloon catheter are the keys to success in this procedure. In our hospital, it is the treatment of choice for choledocholithiasis associated with cholelithiasis. Content Type Journal ArticleDOI 10.1007/s00464-010-0937-xAuthors A. E. B. Sjer, Diakonessenhuis Department of Surgery Utrecht The NetherlandsD. M. Boland, ‘t Lange Land Hospital Department of Surgery P.O. Box 3015 2725 NA Zoetermeer The NetherlandsP. J. J. van Rijn, ‘t Lange Land Hospital Department of Surgery P.O. Box 3015 2725 NA Zoetermeer The N...

Intra-operative sphincterotomy and ERCP for choledocholithiasis during laparoscopic cholecystectomy

Surgery — Mon, 22 Feb 2010 16:02:39 +0100

To the Editors: I read the report by Tekin et al on the intra-operative laparoendoscopic “rendezvous” (LER) versus laparoscopic antegrade sphincterotomy (LAS) for choledocholithiasis with interest. References to the laparoendoscopic treatment of choledocholithiasis (LER) quoted were published between 2000 and 2006. In 1992, I presented a paper on the technique of LER intra-operative sphincterotomy and endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis during laparoscopic cholecystectomy at the World Association Hepato Pancreato Biliary (HPB) Surgery, 4th World Congress Meeting in Hong Kong. (Source: Surgery)

Laparoscopic cholecystectomy for acute cholecystitis should be performed by a laparoscopic surgeon

Surgical Endoscopy — Sat, 20 Feb 2010 06:50:48 +0100

Conclusions Patients who present with acute cholecystitis have a greater chance of a laparoscopically completed cholecystectomy if operated on by a laparoscopy-oriented surgeon. Content Type Journal ArticleDOI 10.1007/s00464-010-0928-yAuthors Kirsten Kortram, St. Antonius Hospital Department of Surgery Koekoekslaan 1, Postbus 2500 3430 EM Nieuwegein The NetherlandsJan Siert Kayitsinga Reinders, St. Antonius Hospital Department of Surgery Koekoekslaan 1, Postbus 2500 3430 EM Nieuwegein The NetherlandsBert van Ramshorst, St. Antonius Hospital Department of Surgery Koekoekslaan 1, Postbus 2500 3430 EM Nieuwegein The NetherlandsMarinus J. Wiezer, St. Antonius Hospital Department of Surgery Koekoekslaan 1, Postbus 2500 3430 EM Nieuwegein The NetherlandsPeter M. N. Y. H. G...

Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial

Surgical Endoscopy — Sat, 20 Feb 2010 06:50:38 +0100

Conclusion SILS cholecystectomy, as well as the invisible scar, has significantly lower abdominal and shoulder pain scores, especially after the first 24 h postoperatively, when this pain is nonexistent. (Registration Clinical Trial number: NTC00872287, www.clinicaltrials.gov). Content Type Journal ArticleDOI 10.1007/s00464-010-0887-3Authors Evangelos C. Tsimoyiannis, G. Hatzikosta General Hospital Departments of Surgery Hippocratus 3, Stavraki GR-45332 Ioannina GreeceKonstantinos E. Tsimogiannis, G. Hatzikosta General Hospital Departments of Surgery Hippocratus 3, Stavraki GR-45332 Ioannina GreeceGeorge Pappas-Gogos, G. Hatzikosta General Hospital Departments of Surgery Hippocratus 3, Stavraki GR-45332 Ioannina GreeceCharalampos Farantos, G. Hatzikosta General ...

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The transversus abdominis plane block: a valuable option for postoperative analgesia? A topical review

Acta Anaesthesiologica Scandinavica — Thu, 18 Feb 2010 00:00:00 +0100

The transversus abdominis plane (TAP) block is a newly described peripheral block involving the nerves of the anterior abdominal wall. The block has been developed for post-operative pain control after gynaecologic and abdominal surgery. The initial technique described the lumbar triangle of Petit as the landmark used to access the TAP in order to facilitate the deposition of local anaesthetic solution in the neurovascular plane. Other techniques include ultrasound-guided access to the neurovascular plane via the mid-axillary line between the iliac crest and the costal margin, and a subcostal access termed the 'oblique subcostal' access. A systematic search of the literature identified a total of seven randomized clinical trials investigating the effect of TAP block on post-operative pain,...

Detection of bacterial DNA in acute and chronic cholecystitis

British Journal of Surgery — Thu, 18 Feb 2010 00:00:00 +0100

The incidence of bacterbilia in cholelithiasis remains controversial. The positivity of cultures ranges from 0 to 73 per cent. The aim of this study was to employ the polymerase chain reaction (PCR) to detect bacterial DNA in gallbladder bile extracted during elective laparoscopic cholecystectomy, and to compare PCR findings with those of bile culture.Bile samples from 84 laparoscopic cholecystectomies were collected for culture and PCR analysis.Positive results for bacterbilia were found in 42 (50 per cent) of 84 patients by PCR but in only 16 patients (19 per cent) by culture (P < 0·001). Agreement between the two methods was seen in 44 samples (52 per cent), which were negative in 35 cases. Pathological examination showed chronic cholecystitis in 69 cases (82 per cent) and acute cholec...

Detection of bacterial DNA in acute and chronic cholecystitis.

The British Journal of Surgery — Thu, 18 Feb 2010 00:00:00 +0100

CONCLUSION:: PCR is more sensitive in detecting bacterial contamination of gallbladder bile in cholecystitis than conventional culture. The clinical relevance of this high sensitivity remains unclear. Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. PMID: 20169571 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)

Technical Challenges in Laparoscopic Cholecystectomy in Situs Inversus

Journal of Laparoendoscopic — Tue, 16 Feb 2010 11:51:58 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques , Vol. 0, No. 0. (Source: Journal of Laparoendoscopic)

Laparoscopic Approach for Suspected Early-Stage Gallbladder Carcinoma [Original Article]

Archives of Surgery — Mon, 15 Feb 2010 20:50:40 +0100

Conclusion Laparoscopic treatment is feasible and safe in selected patients with early-stage gallbladder carcinoma. (Source: Archives of Surgery)

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Single Port Access (SPA) Surgery—a 24-Month Experience

Journal of Gastrointestinal Surgery — Sat, 13 Feb 2010 06:51:23 +0100

Conclusion With initial procedures performed in April 2007, we now report 24-month follow-up of a novel laparoscopic approach utilizing standard instrumentation. We demonstrate that SPA surgery is an alternative to multiport procedures with proposed initial benefits of decreased number of incisions and improved cosmesis for the patient. Long-term prospective randomized large case series will be necessary to assess pain, recovery, and hernia formation proving advantages, if any, over multiport laparoscopy. Content Type Journal ArticleCategory 2009 SSAT Plenary PresentationDOI 10.1007/s11605-009-1081-6Authors Erica R. Podolsky, Drexel University Department of Surgery, College of Medicine 219 North Broad Street, 10th Floor Philadelphia PA 19107 USAPaul G. Curcillo, Drex...

Leiomyoma of the gallbladder: a case report with review of the literature and discussion of the differential diagnosis

Journal of Clinical Pathology — Fri, 12 Feb 2010 10:25:41 +0100

Mesenchymal neoplasms of the gallbladder are rare, and most represent sarcomas of various histological types. To our knowledge, only a few patients with multiple Epstein–Barr virus (EBV)-associated smooth muscle tumours of the gallbladder in the setting of immunodeficiency have been reported in the English literature, but no single case of conventional leiomyoma has been well documented to date. A case of gallbladder leiomyoma in a healthy 34-year-old woman is described here. The tumour was found incidentally on a routine ultrasound examination and was removed by simple cholecystectomy. The patient is alive and well at last follow-up, 6 months after surgery. Histology and immunohistochemistry were consistent with a benign smooth muscle neoplasm that is very similar to conventional ut...

Effect of Dexamethasone on Postoperative Symptoms in Patients Undergoing Elective Laparoscopic Cholecystectomy: Randomized Clinical Trial

World Journal of Surgery — Fri, 12 Feb 2010 07:07:53 +0100

Conclusions The regimen we employed is safe and without apparent side effects. Thus, preoperative dexamethasone can significantly reduce the incidence of PONV, pain and fatigue after elective LC. Content Type Journal ArticleDOI 10.1007/s00268-010-0457-9Authors Petra-Evelyn Sánchez-Rodríguez, Mexican Institute of Social Security Department of Anesthesiology, Specialties Hospital, Western Medical Center Guadalajara Jalisco MexicoClotilde Fuentes-Orozco, Mexican Institute of Social Security Research Unit in Clinical Epidemiology, Specialties Hospital, Western Medical Center Guadalajara Jalisco MexicoAlejandro González-Ojeda, Mexican Institute of Social Security Research Unit in Clinical Epidemiology, Specialties Hospital, Western Medical Center Guadalajara Jalisco Mexi...

Dexamethasone in Patients Undergoing Elective Laparoscopic Cholecystectomy Improves Postoperative Symptoms

World Journal of Surgery — Fri, 12 Feb 2010 07:07:51 +0100

Content Type Journal ArticleCategory Invited CommentaryDOI 10.1007/s00268-010-0438-zAuthors Danny Rosin, Tel Hashomer Israel Journal World Journal of SurgeryOnline ISSN 1432-2323Print ISSN 0364-2313 (Source: World Journal of Surgery)

Emergency open cholecystectomy is associated with markedly lower incidence of postoperative nausea and vomiting (PONV) than elective open cholecystectomy: a retrospective cohort study

BMC Surgery — Fri, 12 Feb 2010 00:00:00 +0100

Background: During a previous study to define and compare incidence risks of postoperative nausea and vomiting (PONV) for elective laparoscopic and open cholecystectomy at two hospitals in Jamaica, secondary analysis comparing PONV risk in elective open cholecystectomy to that after emergency open cholecystectomy suggested that it was markedly reduced in the latter group. The decision was made to collect data on an adequate sample of emergency open cholecystectomy cases and further explore this unexpected finding in a separate study. Methods: Data were collected for 91 emergency open cholecystomy cases identified at the two paricipating hospitals from May 2007 retrograde, as was done for the 175 elective open cholecystectomy cases (from the aforementioned study) with which the emergency ca...

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Update on Instrumentations for Cholecystectomies Performed via Transvaginal Route: State of the Art and Future Prospectives

Diagnostic and Therapeutic Endoscopy — Thu, 11 Feb 2010 15:37:40 +0100

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an innovative approach in which a flexible endoscope enters the abdominal cavity via the transesophageal, transgastric, transcolonic, transvaginal or transvescical route, combining the technique of minimally invasive surgery with flexible endoscopy. Several groups have described different modifications by using flexible endoscopes with different levels of laparoscopic assistance. Transvaginal cholecystectomy (TVC) consists in accessing the abdominal cavity through a posterior colpotomy and using the vaginal incision as a visual or operative port. An increasing interest has arisen around the TVC; nevertheless, the most common and highlighted concern is about the lack of specific instruments dedicated to the vaginal access route. TVC...

Latest updates to UK DUETS

Gastroenterology and Liver Diseases Specialist Library - Liver — Wed, 10 Feb 2010 14:07:57 +0100

We have recently added the following uncertainties to UK DUETS: Bariatric surgery for non-alcoholic steatohepatitis in obese patients Chinese herbal medicines for induction of remission in advanced or late gastric cancer Optimal duration of pegatheron plus ribavirin therapy for chronic hepatitis C in patients with HIV Peginterferon plus ribavirin versus no treatment for chronic hepatitis C in patients with HIV Photodynamic therapy using 5-ALA versus porfimer sodium for Barrett's oesophagus Radiofrequency ablation for Barrett's oesophagus and Barrett's dysplasia Radiofrequency ablation versus surgical resection for oligometastatic hepatic metastases of colorectal cancer Radiofrequency ablation versus surgical resection for resectable hepatic metastases of colorectal cancer Radiofrequency ab...

Latest updates to UK DUETS

Gastroenterology and Liver Diseases Specialist Library - Stomach — Wed, 10 Feb 2010 13:09:54 +0100

Latest updates to UK DUETS

Gastroenterology and Liver Diseases Specialist Library - Colon and rectum — Wed, 10 Feb 2010 13:01:24 +0100

Latest updates to UK DUETS

Wed, 10 Feb 2010 12:42:33 +0100

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Latest updates to UK DUETS

Gastroenterology and Liver Diseases Specialist Library - Prevention — Wed, 10 Feb 2010 12:31:38 +0100

Trait Anxiety Predicts Unsuccessful Surgery in Gallstone Disease

Psychosomatic Medicine — Tue, 09 Feb 2010 22:38:03 +0100

Conclusion: Patients with HTA have a three times higher risk at persisting biliary symptoms at 6 months after cholecystectomy than NHTA patients. Both clinical factors and the patient’s personality should be considered in clinical decision making and risk estimation in elective cholecystectomy. (Source: Psychosomatic Medicine)

Death of Rep. John Murtha Highlights Limitations of Laparoscopic Cholecystectomy

Medscape Today Headlines — Tue, 09 Feb 2010 21:12:41 +0100

Rare accidental injury to intestine can stem from lack of depth perception and/or limited field of vision. Medscape Medical News (Source: Medscape Today Headlines)

Murtha Dead at 77

MedPage Today Public Health — Tue, 09 Feb 2010 15:05:40 +0100

Representative John P. Murtha (D-Pa.), 77, long-time chairman of the House Appropriations Subcommittee on Defense, died Monday afternoon from complications following a planned laparoscopic cholecystectomy, according to a statement from the congressman's office. (Source: MedPage Today Public Health)

Latest updates to UK DUETS

Gastroenterology and Liver Diseases Specialist Library - Oesophagus — Tue, 09 Feb 2010 14:12:53 +0100

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Tue, 09 Feb 2010 13:58:03 +0100

[Analysis of clinical course of severe acute biliary and non biliary pancreatitis: a comparative study.]

Orvosi Hetilap — Sun, 07 Feb 2010 03:46:14 +0100

Conclusion: Female patients suffering from severe biliary acute pancreatitis have higher morbidity and mortality rate. Therefore an elective cholecystectomy is suggested in old female patients with serious co-morbidity and gallstones, before any complications. PMID: 20133246 [PubMed - in process] (Source: Orvosi Hetilap)

Risk-sensitive events during laparoscopic cholecystectomy: the influence of the integrated operating room and a preoperative checklist tool

Surgical Endoscopy — Fri, 05 Feb 2010 08:43:23 +0100

Conclusions Using both an integrated OR and Pro/cheQ has a stronger reducing effect on the number of RSE than using an integrated OR alone. The Pro/cheQ tool supported the optimal workflow in a natural way and raised the general safety awareness amongst all members of the surgical team. For tools such as integrated OR systems and checklists to succeed it is pivotal not to underestimate the value of the implementation process. To further improve safety and quality of surgery, a multifaceted approach should be followed, focusing on the performance and competence of the surgical team as a whole. Content Type Journal ArticleDOI 10.1007/s00464-010-0892-6Authors Sonja N. Buzink, Delft University of Technology Faculty of Industrial Design Engineering Landbergstraat 15 2628...

Technique of open laparoscopy for supramesocolic surgery in obese patients

Surgical Endoscopy — Fri, 05 Feb 2010 08:43:19 +0100

Conclusions We present a technique of open laparoscopy in obese patients, systematically used, for supramesocolic surgery. This technique is safe, reproducible, and permits an efficient closure of the abdominal wall. Content Type Journal ArticleCategory TechniqueDOI 10.1007/s00464-009-0872-xAuthors Jean Baptiste Deguines, Université de Picardie Jules Verne Federation of Digestive Surgery, North Hospital Place Victor Pauchet 80054 Amiens Cedex 01 FranceQuentin Qassemyar, Université de Picardie Jules Verne Federation of Digestive Surgery, North Hospital Place Victor Pauchet 80054 Amiens Cedex 01 FranceAbdennaceur Dhahri, Université de Picardie Jules Verne Federation of Digestive Surgery, North Hospital Place Victor Pauchet 80054 Amiens Cedex 01 FranceOlivier Brehant, ...

A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones

Surgical Endoscopy — Fri, 05 Feb 2010 08:43:05 +0100

Conclusions The results showed equivalent success rate in terms of morbidity and hospital stay. Laparoscopic approach seems to be favorable because of the smaller number of procedures and hospital visits. Content Type Journal ArticleDOI 10.1007/s00464-010-0891-7Authors Virinder K. Bansal, All India Institute of Medical Sciences Department of Surgical Disciplines Room No. 5045, 5th Floor, Teaching Block New Delhi IndiaMahesh C. Misra, All India Institute of Medical Sciences Department of Surgical Disciplines Room No. 5045, 5th Floor, Teaching Block New Delhi IndiaPramod Garg, All India Institute of Medical Sciences Department of Gastroenterology New Delhi IndiaManik Prabhu, All India Institute of Medical Sciences Department of Surgical Disciplines Room No. 5045, 5th Flo...

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Single-port-access (SPATM) cholecystectomy: a multi-institutional report of the first 297 cases

Surgical Endoscopy — Fri, 05 Feb 2010 08:43:01 +0100

Conclusions The findings demonstrate that SPA surgery is an alternative to multiport laparoscopy with fewer scars and better cosmesis. One factor affecting the rate for adoption of SPA surgery among other surgeons is the reproducibility of this new procedure. Although this study had insufficient data to determine fully the benefits of SPA surgery, the feasibility of this procedure with safe, acceptable results was demonstrated in this initial large series across multinational institutions. Content Type Journal ArticleDOI 10.1007/s00464-009-0856-xAuthors Paul G. Curcillo, Drexel University College of Medicine Department of Surgery 219 North Broad Street Philadelphia PA 19107 USAAndrew S. Wu, Drexel University College of Medicine Department of Surgery 219 North Broad S...

Simultaneous/Incidental Cholecystectomy During Gastric/Esophageal Resection: Systematic Analysis of Risks and Benefits

World Journal of Surgery — Fri, 05 Feb 2010 08:34:04 +0100

Conclusions Approximately 6% of patients undergoing upper GI surgery are expected to require cholecystectomy during follow-up. Because late cholecystectomies can be performed safely and because the additional calculated morbidity for these operations is lower than the morbidity for simultaneous cholecystectomy, it cannot generally be recommended to remove a normal acalculous gallbladder during upper GI surgery. Content Type Journal ArticleDOI 10.1007/s00268-010-0444-1Authors Sonja Gillen, Technische Universität München Department of Surgery Ismaningerstrasse 22 81675 Munich GermanyChristoph W. Michalski, Technische Universität München Department of Surgery Ismaningerstrasse 22 81675 Munich GermanyTibor Schuster, Technische Universität München Institute of Medic...

Prompt Cholecystectomy for Mild Pancreatitis Safely Cuts Hospital Stay

Medscape Medical News Headlines — Thu, 04 Feb 2010 17:32:33 +0100

Prompt cholecystectomy in patients with mild pancreatitis is as safe as waiting for symptoms to subside, and it cuts the average hospital stay by roughly 2 days, a new study has shown. Reuters Health Information (Source: Medscape Medical News Headlines)

Laparoscopic cholecystectomy for cholelithiasis in children

Journal of Indian Association of Pediatric Surgeons — Thu, 04 Feb 2010 15:42:45 +0100

Conclusion:</b> Laparoscopic chloecystectomy is a safe and efficacious treatment for pediatric cholelithiasis. The cause for increased incidence of pediatric gallstones and their natural history needs to be further evaluated. (Source: Journal of Indian Association of Pediatric Surgeons)

Prophylactic Cholecystectomy in Midgut Carcinoid Patients

World Journal of Surgery — Thu, 04 Feb 2010 06:44:19 +0100

Conclusions In our study the incidence of gallstone-related complications seems to be higher than in the general population. We recommend that prophylactic cholecystectomy is liberally performed during laparotomy for MGC if patients are planned to undergo treatment with somatostatin analogs. Content Type Journal ArticleDOI 10.1007/s00268-010-0428-1Authors Olov Norlén, Uppsala University Department of Surgery SE-751 85 Uppsala SwedenOla Hessman, Uppsala University Department of Surgery SE-751 85 Uppsala SwedenPeter Stålberg, Uppsala University Department of Surgery SE-751 85 Uppsala SwedenGöran Åkerström, Uppsala University Department of Surgery SE-751 85 Uppsala SwedenPer Hellman, Uppsala University Department of Surgery SE-751 85 Uppsala Sweden Journal Wo...

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Robot-Assisted Pediatric Surgery: How Far Can We Go?

World Journal of Surgery — Wed, 03 Feb 2010 06:47:49 +0100

Conclusions Robot-assisted surgery appears to be safe and feasible for a number of pediatric surgical procedures. Further system improvement and randomized studies are required to evaluate the benefits, if any, and the long-term outcomes of robotic surgery. Content Type Journal ArticleDOI 10.1007/s00268-010-0431-6Authors Aayed Alqahtani, King Saud University Division of Pediatric Surgery, College of Medicine P.O. Box 84147 Riyadh 11671 Saudi ArabiaAbdullrahman Albassam, King Saud University Division of Pediatric Surgery, College of Medicine P.O. Box 84147 Riyadh 11671 Saudi ArabiaMohammed Zamakhshary, King Saud bin Abdulaziz University for Health Sciences Division of Pediatric Surgery Riyadh Saudi ArabiaMohammed Shoukri, King Saud University Division of Pediatric Surge...

Gallbladder duplication: evaluation, treatment, and classification

Journal of Pediatric Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Abstract: Duplicate gallbladder is a rare congenital anomaly resulting from abnormalities in embryogenesis during the fifth and sixth weeks of gestation. Approximately 210 cases have been described. Variations include duplicate, triplicate, and septated gallbladder. We encountered a 15-year-old girl with both a duplicated gallbladder and a duplicated cystic duct who underwent successful laparoscopic cholecystectomy. This combination is extremely unusual, and based upon our findings in this case and a review of the literature, we propose the Unified Classification of Multiple Gallbladders. (Source: Journal of Pediatric Surgery)

Effect of Preoperative Rectal Indomethacin on Postoperative Pain Reduction After Open Cholecystectomy

Journal of PeriAnesthesia Nursing — Mon, 01 Feb 2010 00:00:00 +0100

The preoperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has been shown to have a positive impact on postoperative pain, but there is little research regarding the use of rectal NSAIDs given before surgery. The purpose of this study was to evaluate the effects of rectally administered indomethacin on postoperative pain in patients undergoing open cholecystectomy. A randomized controlled design was used to compare rectally administered indomethacin with placebo. Pain intensity, total opioid dose, and postoperative time to first request for analgesic were evaluated. The indomethacin group experienced significantly less postoperative pain and required less total opioid dose compared with the placebo group. Preoperative rectal administration of indomethacin reduces post...

Effect of Preoperative Rectal Indomethacin on Postoperative Pain Reduction After Open Cholecystectomy.

Journal of Perianesthesia Nursing — Mon, 01 Feb 2010 00:00:00 +0100

Authors: Bahar MM, Jangjoo A, Soltani E, Armand M, Mozaffari S The preoperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has been shown to have a positive impact on postoperative pain, but there is little research regarding the use of rectal NSAIDs given before surgery. The purpose of this study was to evaluate the effects of rectally administered indomethacin on postoperative pain in patients undergoing open cholecystectomy. A randomized controlled design was used to compare rectally administered indomethacin with placebo. Pain intensity, total opioid dose, and postoperative time to first request for analgesic were evaluated. The indomethacin group experienced significantly less postoperative pain and required less total opioid dose compared with the placebo gro...

Prevalence and Risk Factors of Focal Sparing in Hepatic Steatosis.

Ultraschall in der Medizin — Mon, 01 Feb 2010 00:00:00 +0100

CONCLUSION: Sonographic evidence of focal sparing in subjects with hepatic steatosis is associated with an increased risk for metabolic syndrome and may be an easily obtained diagnostic criterion in routine clinical settings. PMID: 20157869 [PubMed - as supplied by publisher] (Source: Ultraschall in der Medizin)

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[Laparoscopic cholecystectomy in totalis situs inversus for cholecystitis.]

Magyar Sebeszet — Mon, 01 Feb 2010 00:00:00 +0100

We report a case of a 68 year old female patient, with a known situs inversus totalis, who underwent a laparoscopic cholecystectomy. We discuss our diagnostic steps (such as US, ERCP and EST), the variation of maneuvers used during the operation. No iatrogenic event occurred. We also stress that the surgeon should be alert of possible local anatomic variations and, if needed, conversion should be a solution of choice. PMID: 20156790 [PubMed - in process] (Source: Magyar Sebeszet)

Preliminary Surgical Results of Single-Incision Transumbilical Laparoscopic Bariatric Surgery

Obesity Surgery — Sat, 30 Jan 2010 18:16:04 +0100

Conclusion Our technique can be safely and effectively used for SITU laparoscopic bariatric surgery. This technique will soon be used for advanced abdominal surgeries besides bariatric ones. Content Type Journal ArticleCategory Clinical ReportDOI 10.1007/s11695-009-0071-9Authors Chih-Kun Huang, E-Da Hospital Department of General Surgery 1 E-Da Road, Jiau-shu Tseun, Yan-chau Shiang Kaohsiung County 824 TaiwanJui-Chi Tsai, E-Da Hospital Bariatric & Metabolic International Surgery Center Kaohsiung TaiwanChi-Hsien Lo, E-Da Hospital Bariatric & Metabolic International Surgery Center Kaohsiung TaiwanJer-Yiing Houng, I-Shou University Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering Kaohsiung County TaiwanYaw-Sen Chen, E-Da Hospital ...

Single Laparoscopic Approach Favored for Common Bile Duct Stones

Medscape Gastroenterology Headlines — Fri, 29 Jan 2010 19:23:43 +0100

For common bile duct stones, a single laparoscopic procedure combining cholecystectomy with bile duct exploration (LCBDE) is best, new research suggests. Reuters Health Information (Source: Medscape Gastroenterology Headlines)

Single-incision laparoscopic cholecystectomy: the first 100 outpatients

Surgical Endoscopy — Fri, 29 Jan 2010 12:15:52 +0100

Conclusions The findings show SIMPL cholecystectomy to be safe in the outpatient setting. It is an excellent alternative to traditional three- or four-port cholecystectomy for the ideal candidate with a lower body mass index (BMI), early disease, and no previous abdominal surgery. The authors’ initial outpatient experience shows that it can be performed using existing instrumentation without increasing costs by a reproducible technique that can be adopted by any practicing general surgeon. Content Type Journal ArticleDOI 10.1007/s00464-010-0886-4Authors Jose Erbella, Manatee Memorial Hospital Department of Surgery 206 Second Street East Bradenton FL 34208 USAGary M. Bunch, Manatee Memorial Hospital Department of Surgery 206 Second Street East Bradenton FL 34208 USA...

Evaluation of Operative Notes Concerning Laparoscopic Cholecystectomy: Are Standards Being Met?

World Journal of Surgery — Fri, 29 Jan 2010 12:14:22 +0100

Conclusions Operative notes do not always fully comply with the standards set forth in the guidelines published in the Netherlands. This could influence adjuvant treatment and future patient treatment, and it may make operative notes less suitable background for other purposes. Therefore operative note writing should be taught as part of surgical training, definitions should be provided, and procedure-specific guidelines should be established to improve the quality of the operative notes and their use to improve patient safety. Content Type Journal ArticleDOI 10.1007/s00268-010-0422-7Authors Linda S. G. L. Wauben, Delft University of Technology Faculty of Industrial Design Engineering Landbergstraat 15 2628 CE Delft The NetherlandsRichard H. M. Goossens, Delft Unive...

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Primary hydatid cyst of the gallbladder: a case report

BioMed Central — Fri, 29 Jan 2010 00:00:00 +0100

Conclusion: Primary hydatid cyst of the gallbladder is a very rare clinical entity. Accurate preoperative diagnostic localization is not always easy, particularly in centers with limited diagnostic tools. (Source: BioMed Central)

A 79-Year-Old Patient With Yellow Sputum

Gastroenterology — Fri, 29 Jan 2010 00:00:00 +0100

Question: A 79-year-old woman was admitted with a 2-day history of vomiting, malaise, and nocturnal yellowish stained cough. She denied having fever or pain. One month earlier she has had an episode of Escherichia coli pneumonia and sepsis. Her history included a cholecystectomy 9 months ago. Postoperatively, a benign bile duct stenosis had caused recurrent episodes of cholangitis and was treated by repeated endoscopic stenting. Furthermore, paroxysmal atrial fibrillation, coronary artery disease, and type 2 diabetes mellitus were present. (Source: Gastroenterology)

Bupivacaine use in the Insuflow® device during laparoscopic cholecystectomy: results of a prospective randomized double-blind controlled trial

Surgical Endoscopy — Thu, 28 Jan 2010 07:01:01 +0100

Conclusions Bupivacaine use in the Insuflow device is safe. No significant differences in postoperative pain were noted in this study compared to using water. Content Type Journal ArticleDOI 10.1007/s00464-009-0804-9Authors Peter W. Zimmer, Penrose-St. Francis Health Services Department of Surgery 2222 North Nevada Avenue Colorado Springs CO 80907 USAMichael J. McCann, Penrose-St. Francis Health Services Department of Surgery 2222 North Nevada Avenue Colorado Springs CO 80907 USAMaureen M. O’Brien, University of Colorado Denver School of Medicine Campus Box C290, 13001 E 17th Place, Building 500, 1st Floor East Aurora CO 80045 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Use of Rigid Nephroscope for Laparoscopic Common Bile Duct Exploration—A Single-Center Experience

World Journal of Surgery — Wed, 27 Jan 2010 20:24:40 +0100

Conclusions A rigid nephroscope can be used for managing all types of common bile duct calculi irrespective of site, size, composition, or degree of impaction. Its use can be expected to become the standard for laparoscopic common bile duct exploration, especially for removing large calculi from a dilated common bile duct. Content Type Journal ArticleDOI 10.1007/s00268-010-0397-4Authors Muneer Khan, Government Medical College Srinagar Department of Surgery Karan Nagar Srinagar 190010 Jammu and Kashmir IndiaSyed Javid Farooq Qadri, Government Medical College Srinagar Department of Surgery Karan Nagar Srinagar 190010 Jammu and Kashmir IndiaSyed Sajad Nazir, Government Medical College Srinagar Department of Surgery Karan Nagar Srinagar 190010 Jammu and Kashmir India ...

Multiple abdominal granuloma caused by spilled gallstones with imaging findings that mimic malignancy

American Journal of Surgery — Wed, 27 Jan 2010 15:28:37 +0100

Abstract: Multiple abdominal granulomas caused by spilled gallstones during a laparoscopic cholecystectomy are a rare complication. The images of the granuloma mimicked malignancy. (Source: American Journal of Surgery)

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Identification of Helicobacter spp. in bile and gallbladder tissue of patients with symptomatic gallbladder disease

HPB: official journal of the International Hepato Pancreat Biliary Association — Wed, 27 Jan 2010 00:00:00 +0100

Discussion: Helicobacter spp. can be detected in bile and gallbladder tissue of patients with benign gallbladder disease. The contribution of these bacteria to the pathophysiology of gallbladder disease and gallstone formation requires further study. (Source: HPB: official journal of the International Hepato Pancreat Biliary Association)

Assessing factors influencing return back to work after cholecystectomy: a qualitative research

BMC Gastroenterology — Wed, 27 Jan 2010 00:00:00 +0100

Conclusions: Physicians perceive their advices as an important factor in patients' duration of sick-leave. In contrast, patients seldom mention this factor and experience physical complaints as the major reason influencing the moment of return to work. (Source: BMC Gastroenterology)

Transcylindrical cholecystectomy under local anesthesia plus sedation. A pilot study

Endoscopy — Tue, 26 Jan 2010 14:23:29 +0100

EndoscopyDOI: 10.1055/s-0029-1243860 The practice of laparoscopic cholecystectomy under local anesthesia is almost anecdotal. For 15 years we have been using a “transcylindrical cholecystectomy” technique for the treatment of cholelithiasis, cholecystitis, and choledocholithiasis. The present study was undertaken to assess the feasibility of transcylindrical cholecystectomy under local anesthesia through a prospective and longitudinal efficacy study.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: Endoscopy)

Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews

Tue, 26 Jan 2010 14:13:53 +0100

Background Patients with symptomatic cholecystolithiasis are treated by three different techniques of cholecystectomy: open, small-incision, or laparoscopic. There is no overview on Cochrane systematic reviews on these three interventions. Objectives To summarise Cochrane reviews that assess the effects of different techniques of cholecystectomy for patients with symptomatic cholecystolithiasis. Methods The Cochrane Database of Systematic Reviews (CDSR) was searched for all systematic reviews evaluating any interventions for the treatment of symptomatic cholecystolithiasis (Issue 4 2008). Main results Three systematic reviews that included a total of 56 randomised trials with 5246 patients are included in this overview of reviews. All three reviews used identical inclusion criteria for tr...

Liver Resection Is Associated with Prolonged Survival for Non-Metastatic Gallbladder Cancer: A 10 Year Review

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:17 +0100

Introduction: Gallbladder cancer is a relatively rare cancer in the United States and is often associated with poor prognosis. We reviewed our experience with treating gallbladder cancer and attempted to identify if demographic, tumor, or surgical factors affected survival in our patient population. Methods: We performed a chart review of the cancer registry of 2 large academic hospitals to identify patients with gallbladder cancer between 1999 and 2007. Demographic information, patient and tumor factors, and survival outcomes were collected. We analyzed the patient population for the impact of patient factors and surgical therapy on survival outcome. Results: Our patient database consisted of 68 patients, 52 of which were women (76%). The ethnic distribution was 37% Hispanic, 34% Caucasia...

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Contributing Factors to Postoperative Length of Stay in Patients Undergoing Laparoscopic Cholecystectomy

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:15 +0100

This study evaluates the major factors that contribute to postoperative length of stay (LOS) for patients undergoing laparoscopic cholecystectomy. Methods: We analyzed demographic, clinical, and utilization data in patients undergoing laparoscopic cholecystectomy in a five-hospital community health system from 1 December 2008 to 31 January 2009. Multiple linear regression analysis was used to evaluate significance and estimate the association between significant factors and LOS. Results: 191 patients met the inclusion criteria for analysis. Demographically, patient age was a significant contributing factor (0.04 days to LOS/year, p=0.004) while gender, diabetes, hypertension, and BMI were not significant. None of the clinical factors (emergency status, use of ERCP, biliary pancreatitis, to...

The Impact of Endoscopic Retrograde Cholangiopancreaticography on Length of Stay

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:15 +0100

Background: Endoscopic retrograde cholangiopancreaticography (ERCP) performed either before or after laparoscopic cholecystectomy (LC) is a commonly used modality for the management of choledocholithiasis. We assess the impact of pre and post-operative ERCP on length of stay. Methods: A retrospective review was done of a prospectively collected database encompassing all patients with biliary disease admitted to the Acute Care Surgery Service over two years. Diagnosis, operations performed, time from admission to operation, length of stay (LOS), and complications were assessed. Results: 190 patients with biliary disease were operated on, with 22 having preop ERCP and 26 postop. There was no difference in the age or co morbidities between the three groups. The patients who did not require ER...

Laparoscopic Cholecystectomy Conversion Rates Two Decades Later: An Analysis of Surgeon and Patient-Specific Factors Resulting in Open Conversion

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:15 +0100

Background: Although we are more than two decades into the laparoscopic era, nationwide laparoscopic cholecystectomy (LC) conversion rates remain in excess of 10% in some series.1 We sought to analyze patient-specific features in converted LCs, and determine the impact of surgeon-specific factors on conversions. Methods: A total of 2,205 LCs (74.7% female and 25.3% males; average age of 50.5 years [range 1-96]) performed at a large tertiary community hospital over a 5-year period (May 2004-October 2008) were analyzed retrospectively. Results: The overall conversion rate for the study period was 4.94%. The number of cholecystectomies peaked in 2006, and the annual rate of attempted LC and conversions varied little throughout the 5-year period (94.81-97.38% and 3.69-7.22%, respectively). Th...

Single Port Access (SPA) Surgery: A Novel Reduced Port Technique for Minimal Access Surgery

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:06 +0100

Introduction: Laparoscopic surgery gained widespread acceptance in general surgery two decades ago with the introduction of laparoscopic cholecystectomy. Although met with skepticism, many laparoscopic procedures are now the standard of care, with the ability to perform virtually any procedure laparoscopically. Although the difficulty of procedures has expanded, the instrumentation and operative techniques have remained stagnant. New approaches such as NOTES have emerged suggesting the need to minimize incisions and potentially speed recovery and reduce analgesic requirements. We introduce a novel technique for accessing the abdomen for minimal access procedures via a single incision, typically hidden within the umbilicus. This technique reduces incisions while using standard, familiar ins...

Will Vascular Surgeons Do General Surgery after Fellowship?

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:04 +0100

Conclusions: As of 2009, the majority of surveyed traditional vascular surgery fellowship trainees will not be including general surgery as part of their future practice. Ongoing surveillance of these trainees may help in general surgery curriculum development in the future. (Source: Journal of Surgical Research)

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Laparoscopic Cholecystectomy in Obese and Non-Obese Children

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:02 +0100

Conclusions: Despite the known surgical challenges with overweight and obese patients, operative times, length of stay, and complication rate remain similar for children undergoing laparoscopic cholecystectomy compared to non-obese children. (Source: Journal of Surgical Research)

Acute Care Surgery Performed by Sleep Deprived Residents: Are Outcomes Affected?

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:22 +0100

Background: The Institute of Medicine recently recommended further reductions in resident duty hours, including a 5-hour rest time for on call residents after 16hours of work, as a way of providing better protection for patients against fatigue-related errors. Yet no data is available regarding outcomes of operations performed by surgical trainees working beyond 16hours in the current 80-hour workweek era. Methods: A retrospective review of all laparoscopic cholecystectomies (LC) and appendectomies performed by surgery residents at a public teaching hospital from July 2003 through March 2009. Operations after 10 PM were performed by residents who began their shift at 6 AM and had thus been working 16hours. A comparison was performed with operations performed between 6 AM and 10 PM (Daytime...

Comparison of Thirty-Day Outcomes after Emergency General Surgery Procedures: Areas for Targeted Improvement

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:21 +0100

Conclusion: All three emergency general surgery procedures were associated with substantial 30-day overall morbidity and serious morbidity/mortality. Most hospitals did not have uniform outcomes across all three procedures. Individual hospitals should examine their procedure-specific outcomes after emergency general surgeries to focus quality improvement initiatives appropriately. (Source: Journal of Surgical Research)

Simultaneous Diagnoses of Biliary Dyskinesia and Gastroparesis in Teenage Girls

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:00 +0100

Conclusions: This is the first report that documents the simultaneous existence of BD and GP. It is possible that there may be some correlation with the enteric nervous system in both diagnoses. In patients with an incomplete response to cholecystectomy for BD, a diagnosis of GP may be considered. (Source: Journal of Surgical Research)

Surgical Novice Response to Laparoscopic Surgery Training on Simulators before and after Training

Journal of Surgical Research — Mon, 25 Jan 2010 16:40:37 +0100

Background: With the current stipulations of the 80-hour work week for residents, surgical programs are faced with dilemma of teaching surgical procedures to residents outside of the operating room. This along with the advancement of minimally invasive surgery and the public apprehension towards the “see one, do one, teach one” curriculum has lead to the introduction of simulation into surgical residency education curriculum. We looked at the ratings of usefulness training on laparoscopic surgical simulators by interns following a 2week period of daily training. We hypothesized that following the period of training novices would rate all modalities as a positive experience in accordance with their previously anticipated ratings. Methods: 32 interns rotating through the general surgery ...

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Refined Task and Proficiency Criteria Is Required for Optimal Virtual Reality Minimally Invasive Surgery Training

Journal of Surgical Research — Mon, 25 Jan 2010 16:40:36 +0100

Conclusions: Task training to expert proficiency improves procedural speed and efficiency. Proficiency based training produces improvement in non-dominant hand use. Regarding the LapMentor II, tasks and proficiency criteria require refinement. Refining expert performance criteria should decrease training time and the number of novices who fail to complete training. (Source: Journal of Surgical Research)

Predictors of In-Hospital Mortality Following Cholecystectomy among Hospitalized Patients

Journal of Surgical Research — Mon, 25 Jan 2010 16:40:25 +0100

Introduction: Gallstone disease is important, occurring in 20% of the US population and carrying the second highest economic burden (nearly $6.5 billion annually) among digestive diseases in the US. Though cholecystectomy is a common procedure, mortality remains significant among certain subsets of the US population. Among adult patients hospitalized for cholecystitis and who underwent cholecystectomy, we identified predictors of in-hospital mortality. Methods: This is a cross-sectional study using the Health Care Utilization Project-Nationwide Inpatient Sample (HCUP-NIS), the largest all-payer type inpatient database in the U.S. We identified all adult patients age 18-100 years, hospitalized in non-federal hospitals with cholecystitis between 1999-2006, who underwent cholecystectomy as th...

Percutaneous Cholecystostomy: A Safe Alternative to Cholecystectomy in High Risk Patients

Journal of Surgical Research — Mon, 25 Jan 2010 16:40:25 +0100

Objective: Cholecystectomy is widely accepted as the treatment of choice for acute cholecystitis. Critically ill, high operative risk patients may require alternate treatment approaches. Percutaneous cholecystostomy (PC) is a minimally invasive procedure that may be of use in this patient population. The purpose of this study was to determine the safety and efficacy of PC in the treatment of acute cholecystitis at a major tertiary referral center. Methods: Records of patients undergoing PC at our institution, between January 2001 and June 2009, were retrospectively reviewed. Data were collected about age, gender, length of stay, admission diagnosis, clinical indices, co-morbidities, indication for PC, American Society of Anaesthesiologists (ASA) physical status classification, radiologic f...

Infection frequently triggers thrombotic microangiopathy in patients with preexisting risk factors: A single-institution experience

Journal of Clinical Apheresis — Mon, 25 Jan 2010 00:00:00 +0100

We report a retrospective analysis of 65 patients presenting to our institution from 1997 to 2008 with all forms of thrombotic microangiopathy. Therapeutic plasma exchange was a requirement for analysis and 65 patients were referred to our institution; 66% of patients were female and median age at presentation was 52 years. Bacterial infection was the most commonly identified etiologic factor and in the multivariate model was the only significant variable associated with survival outcome (odds ratio 5.1, 95% confidence interval, 1.2-21.7). As infection can be considered a common trigger event for thrombotic microangiopathy, patients with hepatobiliary sepsis may benefit from elective cholecystectomy. We conclude that bacterial infection frequently triggers TTP and other thrombotic microang...

Results of laparoscopic cholecystectomy without energized dissection: A prospective study

International Journal of Surgery — Mon, 25 Jan 2010 00:00:00 +0100

Conclusion: The potential injury from use of energy sources in LC can be avoided as it can be safely performed without using any energy source. (Source: International Journal of Surgery)

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Pediatric cholelithiasis and laparoscopic management: A review of twenty two cases

Journal of Minimal Access Surgery — Fri, 22 Jan 2010 15:41:18 +0100

Conclusion:</b> Laparoscopic chloecystectomy is confirmed to be a safe and efficacious treatment for pediatric cholelithiasis. The cause for an increased incidence of pediatric gallstones and their natural history need to be further evaluated. (Source: Journal of Minimal Access Surgery)

Perioperative management for a patient with chronic pancytopenia: a case of aplastic anemia with persistent neutropenia following preoperative administration of G-CSF

Journal of Anesthesia — Fri, 22 Jan 2010 10:09:15 +0100

Abstract The patient, a 62-year-old male suffering from aplastic anemia for 6 years, was admitted in order to undergo laparoscopic cholecystectomy for cholecystitis. Results of laboratory tests at the time of admission revealed pancytopenia: white blood cell count, 1.94 × 103/µl (neutrophil count, 1.23 × 103/µl); red blood cell count, 2.09 × 106/µl; Hb 7.5 g/dl; and platelet count, 3.7 × 104/µl. The patient received supportive therapy prior to surgery, including blood transfusion of red blood cells, platelets and granulocyte colony-stimulating factor (G-CSF). On the day of surgery, the white blood cell count increased to 3.93 × 103/µl (neutrophil count, 2.75 × 103/µl). Surgery ended with no intr...

[Single Port Thorascopic Surgery Using the SILS((R)) Tool as a Novel Method in the Surgical Treatment of Pneumothorax.]

Archivos de Bronconeumologia — Tue, 19 Jan 2010 00:00:00 +0100

We describe the first cases of video-assisted thoracic surgery (VATS) in spontaneous pneumothorax using the SILS system. There are no previous reports on the use of the SILS system in VATS for spontaneous pneumothorax. This system also allows us to obtain a more cosmetic surgical result, as well as decreasing the mean post-operative hospital stay and the need for analgesics to improve the post-operative pain. PMID: 20092928 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

Prospective Randomized Trial of LC+LCBDE vs ERCP/S+LC for Common Bile Duct Stone Disease [Original Article]

Archives of Surgery — Mon, 18 Jan 2010 20:51:24 +0100

Conclusions Both ERCP/S+LC and LC+LCBDE were highly effective in detecting and removing common bile duct stones and were equivalent in overall cost and patient acceptance. However, the overall duration of hospitalization was shorter and physician fees lower for LC+LCBDE. Trial Registration clinicaltrials.gov Identifier: NCT00807729 (Source: Archives of Surgery)

The Pedicle Effect and Direct Coupling: Delayed Thermal Injuries to the Bile Duct After Laparoscopic Cholecystectomy [Resident's Forum]

Archives of Surgery — Mon, 18 Jan 2010 20:51:24 +0100

We report a series of 3 patients who underwent uneventful laparoscopic cholecystectomies but were readmitted 4 to 5 days later with pinhole leaks from the common bile duct as a result of coagulative necrosis caused by unrecognized energy transfer. We suggest that surgeons keep the use of monopolar diathermy to a minimum while dissecting near vital structures. (Source: Archives of Surgery)

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Retroperitoneal abscess with consecutive acute renal failure caused by a lost gallstone 2 years after laparoscopic cholecystectomy

Langenbeck's Archives of Surgery — Sat, 16 Jan 2010 06:58:00 +0100

Abstract A 70-year-old male patient presented with abdominal pain, acute renal failure, and fever 2 years after laparoscopic cholecystectomy. During the surgical drainage of the abscess formation on the patient’s right flank, a huge gallstone was found in the retroperitoneum. The patient was dismissed from the hospital 11 days after admission with normal lab panel and restored renal function. Content Type Journal ArticleCategory Case Management & Clinical ConsequencesDOI 10.1007/s00423-009-0587-4Authors Christoph Justinger, University of the Saarland Department of General, Visceral, Vascular and Pediatric Surgery D-66421 Homburg Saarland GermanyJens Sperling, University of the Saarland Department of General, Visceral, Vascular and Pediatric Surgery D-66421 Hom...

[Case Report] An innocent gallbladder?

LANCET — Fri, 15 Jan 2010 00:00:00 +0100

In December, 2008, a 66-year-old man was admitted to our hospital for nausea and abdominal pain, with two episodes of vomiting in the previous few hours. He had had a constant right upper quadrant pain radiating to his back and side for 5 days; he denied fever or chills. Physical examination showed absence of bowel sounds. Ultrasonography showed multiple gallstones, at least one of which had migrated to the main biliary tract, so he underwent an uncomplicated laparoscopic cholecystectomy, with prompt recovery. (Source: LANCET)

Single-incision laparoscopic cholecystectomy: Single institution experience and literature review.

World Journal of Gastroenterology : WJG — Wed, 13 Jan 2010 18:44:11 +0100

We report one of the initial clinical experiences in Japan with this new technique. Four cases of gallbladder diseases were selected for this new technique. A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus. A 12-mm trocar was placed through an open approach, and the abdominal cavity was explored with a 10-mm semi-flexible laparoscope. Two 5-mm ports were inserted laterally from the laparoscope port. A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder. Dissection was performed using an electric cautery hook and an Endograsper roticulator. There were two women and two men with a mean age of 50.5 years (range: 40-61 years). All procedures were completed successfully without any perioperative complications. In all cases, there wa...

The clinical presentations of ectopic biliary drainage into duodenal bulbus and stomach with a thorough review of the current literature

BMC Gastroenterology — Tue, 12 Jan 2010 00:00:00 +0100

Conclusion: With this report, we have to remind that ectopic biliary drainage must be considered in the differential diagnosis when the clinician faces cases with gastric outlet obstruction due to peptic ulcer formation accompanied by cholangitis/cholestasis. (Source: BMC Gastroenterology)

Endoscopic management of postoperative bile duct injuries: A single center experience

The Saudi Journal of Gastroenterology — Fri, 08 Jan 2010 14:17:48 +0100

Conclusions:</b> Endoscopic therapy is safe and effective in the management of postoperative bile duct leak. For postoperative bile ductal strictures, ERCP is a less favorable option. (Source: The Saudi Journal of Gastroenterology)

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Early Laparoscopic Surgery Best for Acute Cholecystitis

Medscape Today Headlines — Thu, 07 Jan 2010 16:20:34 +0100

An update of a Cochrane Hepato-Biliary Group systematic review published in 2006 reaffirms that early laparoscopic cholecystectomy performed during acute cholecystitis seems safe and is associated with a shorter hospital stay than delaying the surgery until symptoms settle. Reuters Health Information (Source: Medscape Today Headlines)

Laparoscopic radical cholecystectomy and Roux-en-Y choledochojejunostomy for gallbladder cancer

Surgical Endoscopy — Thu, 07 Jan 2010 16:14:34 +0100

Conclusion The minimally invasive approach to gallbladder cancer is feasible and safe. It should currently be performed in high-volume centers with expertise in both hepatobiliary and minimally invasive surgery. Larger trials are needed to determine whether either the open or laparoscopic approach offers any advantage. Content Type Journal ArticleCategory Dynamic ManuscriptDOI 10.1007/s00464-009-0840-5Authors Andrew A. Gumbs, Fox Chase Cancer Center Department of Surgical Oncology 333 Cottman Avenue, C-308 Philadelphia PA 19111 USAJohn P. Hoffman, Fox Chase Cancer Center Department of Surgical Oncology 333 Cottman Avenue, C-308 Philadelphia PA 19111 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Laparoscoendoscopic single-site cholecystectomy and occult gallbladder cancer

Surgical Endoscopy — Thu, 07 Jan 2010 16:13:23 +0100

Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0843-2Authors Pascal Bucher, University Hospital Geneva Department of Surgery 24 rue Micheli-du-Crest 1211 Geneva SwitzerlandFrançois Pugin, University Hospital Geneva Department of Surgery 24 rue Micheli-du-Crest 1211 Geneva SwitzerlandPhilippe Morel, University Hospital Geneva Department of Surgery 24 rue Micheli-du-Crest 1211 Geneva Switzerland Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Ramosetron versus ondansetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

Surgical Endoscopy — Wed, 06 Jan 2010 18:05:10 +0100

Content Type Journal ArticleCategory Letter-ReplyDOI 10.1007/s00464-009-0851-2Authors Sang-Hwan Do, Seoul National University Bundang Hospital Department of Anesthesiology and Pain Medicine Seongnam-si South KoreaJunghee Ryu, Seoul National University Bundang Hospital Department of Anesthesiology and Pain Medicine Seongnam-si South Korea Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Biliary Complications Secondary to Post-Cholecystectomy Clip Migration: A Review of 69 Cases

Journal of Gastrointestinal Surgery — Tue, 05 Jan 2010 06:50:38 +0100

Conclusion PCCM can occur at any time but typically occur at a median of 2 years after cholecystectomy. Clinical presentations are similar to those with primary or secondary choledocholithiasis. Most can be managed successfully with ERCP. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11605-009-1131-0Authors Vui Heng Chong, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital Endoscopy Unit Bandar Seri Begawan BA 1710 Brunei DarussalamChee Fui Chong, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital Department of Surgery Bandar Seri Begawan BA 1710 Brunei Darussalam Journal Journal of Gastrointestinal SurgeryOnline ISSN 1873-4626Print ISSN 1091-255X (Source: Journal of Gastrointestinal Surgery)

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Effectively Relieving Pain After Laparoscopic Cholecystectomy

Health News from Medical News Today — Sun, 03 Jan 2010 08:00:00 +0100

Fibrin sealant has been an extremely effective and widely used adjunct to surgical procedures to control diffuse slow bleeding over large surfaces. In addition, fibrin sealant has been used as a carrier for other compounds. Thus, it has been used to release medicines slowly at a fixed site and is therefore effective for a long time. A study led by Jian-Zhu Fu from the Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, has recently been published in the World Journal of Gastroenterology... (Source: Health News from Medical News Today)

Effectively Relieving Pain After Laparoscopic Cholecystectomy

Pain / Anesthetics News From Medical News Today — Sun, 03 Jan 2010 08:00:00 +0100

Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones

Surgical Endoscopy — Fri, 01 Jan 2010 06:44:38 +0100

Conclusions The study advocates single-session laparoscopic cholecystectomy with transcystic CBD exploration as a feasible first choice treatment and the logical next step in the management of patients with CBD stones. Content Type Journal ArticleDOI 10.1007/s00464-009-0809-4Authors Faisal Hanif, Monklands Hospital, NHS Lanarkshire Airdrie ML6 0JS UKZubir Ahmed, Monklands Hospital, NHS Lanarkshire Airdrie ML6 0JS UKM. Abdel Samie, Monklands Hospital, NHS Lanarkshire Airdrie ML6 0JS UKAhmad H. M. Nassar, Monklands Hospital, NHS Lanarkshire Airdrie ML6 0JS UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Impact of established skills in open surgery on the proficiency gain process for laparoscopic surgery

Surgical Endoscopy — Fri, 01 Jan 2010 06:44:37 +0100

Conclusions Prior open experience does not aid the laparoscopic learning process, as demonstrated in a simulated setting. Given the wealth of evidence demonstrating translation of virtual skills to the operating theater, we propose that the safe and effective introduction of well-supervised laparoscopic training may be possible at the beginning of a surgical training curriculum. Content Type Journal ArticleDOI 10.1007/s00464-009-0792-9Authors Daniel C. Brown, Imperial College, St Mary’s Hospital Department of Biosurgery and Surgical Technology Praed St London W2 1N UKDanilo Miskovic, Imperial College, St Mary’s Hospital Department of Biosurgery and Surgical Technology Praed St London W2 1N UKBenjie Tang, Ninewells Hospital and Medical School Cuschieri Skills Centr...

Acquired biliary diseases in children

Paediatrics and Child Health — Fri, 01 Jan 2010 00:00:00 +0100

Abstract: Acquired biliary diseases are far less common in children than in adults and include gallstones, acalculous cholecystitis, biliary dyskinesia, primary sclerosing cholangitis (PSC) and benign biliary strictures. Gallstones have been increasingly diagnosed in children in recent years mainly due to increasing use of ultrasonography. The etiologies of cholelithiasis are hemolytic (20%–50%), other known etiology (30%–40%) such as total parenteral nutrition, ileal disease, congenital biliary diseases and idiopathic (20%). Spontaneous resolution of gallstones is frequent in infants and hence a period of observation is recommended even for choledocholithiasis. Children with gallstones can present with typical biliary symptoms (50%), nonspecific symptoms (25%), be asymptomatic (20%) o...

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[Critical reappraisal of cholecystectomy in patients with asymptomatic gallstones for early diagnosis and removal of dysplasia and cancer.]

Korean J Gastroenter... — Fri, 01 Jan 2010 00:00:00 +0100

Conclusions: Extending indication of prophylactic cholecystectomy in patients with asymptomatic GS without polyp to prevent GB dysplasia or cancer beyond the existing indication does not seem to be justifiable in Korea. However, further studies are needed in patients with asymptomatic GS and polyp of any size. PMID: 20098067 [PubMed - in process] (Source: Korean J Gastroenter...)

[Gallstone biochemical characteristics using Fourier transform infrared spectroscopy method.]

Annales de Biologie Clinique — Fri, 01 Jan 2010 00:00:00 +0100

This study reports biochemical composition and morphological aspect of gallstones as investigated by spectroscopy IR method. Participants were 24 patients composed of 12 males and 12 females who underwent cholecystectomy with age mean of 44.8 years. The gallstones were classified either as pigments stones (n = 12), cholesterol stones (n = 8) or as mixed stones (n = 4) according to analysis by Fourier transform infrared spectroscopy. The infrared spectroscopy quantification reported eight stones contained 100% of cholesterol, eight of 100% of calcium bilirubinate, four stones were composed of 65% calcium bilirubinate phosphate and 35% calcium carbonate, and four stones contained 65% cholesterol, 30% neutral calcium bilirubinate, 5% protein and traces of calcium bilirubinate acid. Our findin...

[Solid pseudopapillary tumor of the pancreas: case report and literature review.]

Cirugia y Cirujanos — Fri, 01 Jan 2010 00:00:00 +0100

Conclusions: One may conclude that the solid pseudopapillary tumor is a differential diagnosis in the presence of pancreatic tumors, although due to its rarity it is not the first option to discard. Surgery represents the best treatment for this pathological entity and should be attempted in all cases, independent of the size of the pancreatic injury. PMID: 20226131 [PubMed - in process] (Source: Cirugia y Cirujanos)

Basic research Hepatic mRNA expression of histone (H3): an early predictor of tumorgenic changes in chronic hepatitis C

Articles of Archives of Medical Science - TERMEDIA publishing house — Wed, 30 Dec 2009 12:26:09 +0100

Conclusions: It could be concluded that alterations of hepatic expression of histone H3 mRNA quantitatively (increased expression) and qualitatively (nuclear-cytoplasmic shift) may be used for early prediction of tumorgenic changes in CHC. (Source: Articles of Archives of Medical Science - TERMEDIA publishing house)

Findings at endoscopic retrograde cholangiopancreatography after endoscopic treatment of postcholecystectomy bile leaks

Surgical Endoscopy — Wed, 30 Dec 2009 06:53:08 +0100

Conclusion After endoscopic treatment of a bile leak, the prevalence of abnormalities at follow-up ERC is significant. A repeat cholangiogram with a balloon sweep is preferred at the time of stent removal. Content Type Journal ArticleDOI 10.1007/s00464-009-0842-3Authors Gregory A. Coté, Washington University School of Medicine Division of Gastroenterology 660 South Euclid Avenue Campus Box 8124 St. Louis MO 63110 USAMichael Ansstas, Washington University School of Medicine Division of Gastroenterology 660 South Euclid Avenue Campus Box 8124 St. Louis MO 63110 USASomal Shah, Washington University School of Medicine Division of Gastroenterology 660 South Euclid Avenue Campus Box 8124 St. Louis MO 63110 USARajesh N. Keswani, Washington University School of Medicine Divis...

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Isolated blunt traumatic gallbladder perforation demonstrated on MDCT and post-cholecystectomy bile leak revealed on Gd-EOB-DTPA (Primovist) enhanced MRCP

European Journal of Radiology Extra — Wed, 30 Dec 2009 00:00:00 +0100

We report a rare case of isolated gallbladder injury following blunt abdominal trauma identified on MDCT prior to surgery. The patient had a bile leak post-operatively which was demonstrated on biliary phase Gd-EOB-DTPA (Primovist) enhanced MRI. (Source: European Journal of Radiology Extra)

Single-port laparoscopic cholecystectomy: initial experience

Surgical Endoscopy — Tue, 29 Dec 2009 06:54:14 +0100

Conclusion The results from the current series show single-port laparoscopic cholecystectomy to be a promising technique. A variety of patient demographics appear suited to this approach. The operative time in this series compares favorably with that for the standard four-port operation. The feasibility of single-port laparoscopic cholecystectomy is now established. However, routine application of this novel technique requires an evaluation of its safety and cost effectiveness in larger studies. In addition, its superiority over standard laparoscopic cholecystectomy in terms of postoperative pain, cosmesis, and overall patient satisfaction requires further study. Refinements in instrumentation will enable wider use of this novel minimally invasive approach. Content T...

Current experiences with robotic surgery at Severance Hospital, Yonsei University in Korea

Asian Journal of Endoscopic Surgery — Sun, 27 Dec 2009 00:00:00 +0100

We started performing laparoscopic cholecystectomies in 1991. Since that time, many surgeons have been trained in laparoscopic and minimally invasive surgery, and laparoscopic surgery has been used in numerous procedures, with patients benefitting as a result. We performed the first automated surgery in Korea using Automated Endoscopic System for Optimal Positioning in June 1996. Inspired by Inbae Yoon and assisted by his generous donation, our hospital started the IB Yoon Multi-Specialty Endoscopic Research & Training Center in 1998. Subsequently in March 2005, we started the Severance Robotic and Minimally Invasive Surgery Center. The establishment of these centers has enabled us to widen the use of laparoscopic surgery and to teach many surgeons the principles of and the techniques invo...

Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients

Surgical Endoscopy — Fri, 25 Dec 2009 06:55:18 +0100

Conclusion The SILC technique with a two-trocar technique is safe, feasible, and reproducible. The operating times are reasonable and can be lessened with experience. Even complex cases can be managed with this technique. Excellent exposure of the critical view was obtained in all cases. The SILC procedure is becoming the standard of care for most of the authors’ elective patients with gallbladder disease. Clinical trials are warranted before the SILC technique is adopted universally. Content Type Journal ArticleDOI 10.1007/s00464-009-0786-7Authors Homero Rivas, University of Texas Southwestern Department of Surgery, Division of Gastrointestinal and Endocrine Surgery 5323 Harry Hines Boulevard Dallas TX 75390-8819 USAEsteban Varela, Washington University in St. Lou...

Providing more through less: current methods of retraction in SIMIS and NOTES cholecystectomy

Surgical Endoscopy — Fri, 25 Dec 2009 06:55:11 +0100

Conclusion Adequate retraction greatly simplifies SIMIS and NOTES surgery. Endograb internal retractors were easy to use and were found to provide optimal retraction and exposure during these procedures without complications. Content Type Journal ArticleDOI 10.1007/s00464-009-0807-6Authors Avraham Schlager, Hadassah-Hebrew University Medical Center Department of Surgery P.O. Box 12000 Jerusalem 91120 IsraelAbed Khalaileh, Hadassah-Hebrew University Medical Center Department of Surgery P.O. Box 12000 Jerusalem 91120 IsraelNoam Shussman, Hadassah-Hebrew University Medical Center Department of Surgery P.O. Box 12000 Jerusalem 91120 IsraelRam Elazary, Hadassah-Hebrew University Medical Center Department of Surgery P.O. Box 12000 Jerusalem 91120 IsraelAndrei Keidar, Hadassa...

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Gaze disruptions experienced by the laparoscopic operating surgeon

Surgical Endoscopy — Thu, 24 Dec 2009 19:57:02 +0100

Conclusions This study of laparoscopic cholecystectomy performance reveals a high gaze disruption rate in the current operating room work environment. Improvements aimed at reducing such disruptions—and thus potentially surgical error—should center on better instrument design and realigning the axis between surgeon’s eye and visual display. Content Type Journal ArticleDOI 10.1007/s00464-009-0753-3Authors Erica Sutton, University of Maryland School of Medicine Department of Surgery Baltimore MD USAYassar Youssef, University of Maryland School of Medicine Department of Surgery Baltimore MD USANora Meenaghan, University of Maryland School of Medicine Department of Surgery Baltimore MD USACarlos Godinez, Naval Air Station Jacksonville Hospital Department of General ...

Performance value of high risk factors in colorectal cancer screening in China.

World Journal of Gastroenterology : WJG — Thu, 24 Dec 2009 08:54:24 +0100

CONCLUSION: The iFOBT may be the best marker for screening for advanced neoplasias and adenomas. Some unique high risk factors may play an important role in CRC screening in China. PMID: 20027686 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)

Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

British Journal of Surgery — Thu, 24 Dec 2009 00:00:00 +0100

In many countries laparoscopic cholecystectomy for acute cholecystitis is mainly performed after the acute episode has settled because of the anticipated increased risk of morbidity and higher conversion rate from laparoscopic to open cholecystectomy.A systematic review was performed with meta-analysis of randomized clinical trials of early laparoscopic cholecystectomy (ELC; performed within 1 week of onset of symptoms) versus delayed laparoscopic cholecystectomy (performed at least 6 weeks after symptoms settled) for acute cholecystitis. Trials were identified from The Cochrane Library trials register, Medline, Embase, Science Citation Index Expanded and reference lists. Risk ratio (RR) or mean difference was calculated with 95 per cent confidence intervals (c.i.) based on intention-to-tr...

Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

British Journal of Surgery — Thu, 24 Dec 2009 00:00:00 +0100

A recent systematic review found early laparoscopic cholecystectomy (ELC) to be safe and to shorten total hospital stay compared with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis. The cost-effectiveness of ELC versus DLC for acute cholecystitis is unknown.A decision tree model estimating and comparing costs to the UK National Health Service (NHS) and quality-adjusted life years (QALYs) gained following a policy of either ELC or DLC was developed with a time horizon of 1 year. Uncertainty was investigated with probabilistic sensitivity analysis, and value-of-information analysis estimated the likely return from further investment in research in this area.ELC is less costly (approximately - £820 per patient) and results in better quality of life (+0·05 QALYs per patie...

Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

The British Journal of Surgery — Thu, 24 Dec 2009 00:00:00 +0100

CONCLUSION:: ELC during acute cholecystitis appears safe and shortens the total hospital stay. Copyright (c) 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. PMID: 20035546 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)

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Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

The British Journal of Surgery — Thu, 24 Dec 2009 00:00:00 +0100

CONCLUSION:: The results of this decision analytic modelling study suggest that on average ELC is less expensive and results in better quality of life than DLC. Future research should focus on quality-of-life measures alone. Copyright (c) 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. PMID: 20035545 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)

Intraoperative Near-Infrared Fluorescent Cholangiography (NIRFC) in Mouse Models of Bile Duct Injury

World Journal of Surgery — Wed, 23 Dec 2009 22:12:40 +0100

Conclusions Near-infrared fluorescent agents with hepatobiliary excretion may be used intraoperatively to visualize extrahepatic biliary anatomy and physiology. Used in conjunction with laparoscopic imaging technologies, the use of this technique should enhance hepatobiliary surgery. Content Type Journal ArticleDOI 10.1007/s00268-009-0332-8Authors Jose-Luiz Figueiredo, Massachusetts General Hospital and Harvard Medical School Center for Molecular Imaging Research Building 149, 13th Street Charlestown MA 02129 USACory Siegel, Massachusetts General Hospital and Harvard Medical School Center for Molecular Imaging Research Building 149, 13th Street Charlestown MA 02129 USAMatthias Nahrendorf, Massachusetts General Hospital and Harvard Medical School Center for Molecular I...

Cholecystectomy by Single Trocar Access (SITRACC): The First Multicenter Study.

Surgical Innovation — Tue, 22 Dec 2009 00:00:00 +0100

CONCLUSION: A cholecystectomy using the SITRACC method is feasible and safe. PMID: 20031944 [PubMed - as supplied by publisher] (Source: Surgical Innovation)

Impact of Advancing Age on Abdominal Surgical Outcomes [Original Article]

Archives of Surgery — Mon, 21 Dec 2009 20:52:21 +0100

Conclusions Among older adults, the risk of complications and early death after commonly performed abdominal procedures is greater than previously reported. These rates should be considered in ongoing quality improvement initiatives and may be helpful when counseling patients regarding abdominal operations. (Source: Archives of Surgery)

Painless Obstructive Jaundice Secondary to a Common Bile Duct Abscess: A Delayed Sequela of Cholecystectomy

HPB Surgery — Mon, 21 Dec 2009 15:21:07 +0100

Complications related to cholecystectomy are well described. Most occur in the early postoperative period and are recognised either at the time of, or shortly after surgery. Clinical sequelae occurring years following cholecystectomy are rare and infrequently reported. In addition, most delayed complications are related to the continuing presence or new formation of gallstones. In this paper we present a unique case of an abscess of the common bile duct wall, presenting with painless obstructive jaundice more than 30 years following an open cholecystectomy, without the presence of gallstones. The clinical presentation, investigations, and treatment are discussed with a review of other relevant reported cases in the literature. (Source: HPB Surgery)

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The use of minimally invasive surgery for lymph node recurrence after endoscopic mucosal resection of superficial esophageal cancer

Esophagus — Mon, 21 Dec 2009 06:40:57 +0100

Abstract A 73-year-old man was diagnosed with superficial esophageal cancer, and endoscopic mucosal resection was performed. Histologically, the lesion was found to be a squamous cell carcinoma invading the muscularis mucosae without vascular invasion. The patient was followed without being given adjuvant therapy, and lymph node recurrence along the lesser curvature of the stomach was found after 2.5 years. He underwent laparoscopic removal of the metastatic lymph node and cholecystectomy for cholecystolithiasis. He had two courses of adjuvant chemotherapy and showed no recurrence during 3 years of observation. Although the effectiveness of surgical resection for nodal recurrence of esophageal cancer remains controversial, this case highlights the possibility of salvage re...

How to relieve the pain effectively after laparoscopic cholecystectomy?

EurekAlert! - Medicine and Health — Mon, 21 Dec 2009 05:00:00 +0100

(World Journal of Gastroenterology) Although the pain after laparoscopic cholecystectomy (LC) is markedly less than the pain after open cholecystectomy, pain is still the patient's first complaint after LC. A recent study found that implanting fibrin sealant with sustained-release ropivacaine in the gallbladder bed could relieve the pain after LC. (Source: EurekAlert! - Medicine and Health)

[Changes in liver function and immune function following laparoscopic and traditional open cholecystectomy: a comparative study.]

Journal of Southern Medical University — Sun, 20 Dec 2009 00:00:00 +0100

CONCLUSION: LC and OC show no significant difference in the effects on the liver function and immune function. PMID: 20034911 [PubMed - as supplied by publisher] (Source: Journal of Southern Medical University)

Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy

American Journal of Surgery — Fri, 18 Dec 2009 15:21:38 +0100

Abstract: Hepatic artery pseudoaneurysm is a rare and potentially fatal complication of laparoscopic cholecystectomy that often presents with abdominal pain, anemia, hemobilia, and liver function elevations. The authors report a case of hepatic artery pseudoaneurysm diagnosed by abdominal computed topography in a 54-year-old man who had undergone laparoscopic cholecystectomy the previous month. Definitive treatment was angiography with embolization. (Source: American Journal of Surgery)

Fundamentals of Laparoscopic Surgery simulator training to proficiency improves laparoscopic performance in the operating room—a randomized controlled trial

American Journal of Surgery — Fri, 18 Dec 2009 15:21:37 +0100

Conclusions: This study clearly demonstrates the educational value of FLS simulator training in surgical residency curricula. (Source: American Journal of Surgery)

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Laparoscopic simulation training with proficiency targets improves practice and performance of novice surgeons

American Journal of Surgery — Fri, 18 Dec 2009 15:21:36 +0100

Conclusions: Delineation of proficiency targets with reporting of progress improves interns' practice results, and appears to have a positive effect on their early operating room (OR) performance of laparoscopic cholecystectomy. (Source: American Journal of Surgery)

The President's gallbladder: A historical account of the cholecystectomy of Lyndon Baines Johnson

Surgery — Thu, 17 Dec 2009 15:22:53 +0100

From George Washington's teeth to George W. Bush's torn meniscus, Presidential health has stirred stock markets, fascinated physicians, and altered planet politics. The medical management of his wound and subsequent death of President Abraham Lincoln altered the course of post-Civil War reconstruction, the results of which we continue to struggle with today. Woodrow Wilson's poor health in the last years of his presidency delayed the effectiveness of the League of Nations and its eventual evolution to the United Nations. President Eisenhower's major heart attack on September 24, 1955, caused a major slide in the U.S. stock markets 2 days later. In 1965, President Lyndon Baines Johnson underwent elective cholecystectomy with a relatively uneventful recovery while in office, but the potentia...

Safety and efficacy of triple therapy with ezetimibe/simvastatin plus extended-release niacin in patients with hyperlipidaemia

NeLM - Cardiovascular Medicine — Thu, 17 Dec 2009 00:00:00 +0100

Source: Reuters Health News Area: News According to the results of a study published in the American Journal of Cardiology, triple therapy with ezetimibe, simvastatin and extended-release niacin is more effective than dual therapy with simvastatin and ezetimibe in high-risk patients with hyperlipidaemia. To investigate the long term safety and efficacy of triple therapy with ezetimibe/simvastatin (E/S) plus extended-release niacin, researchers studied 942 patients with type IIa/IIb hyperlipidemia for 64 weeks in a randomised, double-blind study. Patients were randomised to one of four arms: E/S (10/20 mg) plus niacin (to 2 g) or E/S (10/20 mg) for 64 weeks, or niacin (to 2 g) for 24 weeks and then E/S (10/20 mg) plus niacin (2 g) or E/S (10/20 mg) for an additional 4...

In-hospital mortality after resection of biliary tract cancer in the United States

HPB: official journal of the International Hepato Pancreat Biliary Association — Tue, 15 Dec 2009 00:00:00 +0100

Objective: To assess perioperative mortality following resection of biliary tract cancer within the U.S.Background: Resection remains the only curative treatment for biliary tract cancer. However, current data on operative mortality after surgical resections for biliary tract cancer are limited to small and single-center studies.Methods: Using the Nationwide Inpatient Sample 1998[ndash]2006, a cohort of patient-discharges was assembled with a diagnosis of biliary tract cancer, including intrahepatic bile duct, extrahepatic bile duct, and gall bladder cancers. Patients undergoing resection, including hepatic resection, bile duct resection, pancreaticoduodenectomy, and cholecystectomy, were retained. The primary outcome measure was in-hospital mortality. Categorical variables were analyzed b...

Long-term prognosis of bile duct stones: endoscopic papillary balloon dilatation versus endoscopic sphincterotomy

Digestive Endoscopy — Tue, 15 Dec 2009 00:00:00 +0100

Conclusion: Low-pressure EPBD in combination with isosorbide dinitrate enabled preservation of papillary functions by 70%, which would improve a long-term prognosis. (Source: Digestive Endoscopy)

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Should Subcostal and Lateral Trocars Be Used in Laparoscopic Cholecystectomy? A Randomized, Prospective Study

Journal of Laparoendoscopic — Mon, 14 Dec 2009 18:46:36 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques Dec 2009, Vol. 19, No. 6: 749-753. (Source: Journal of Laparoendoscopic)

Effect of implanting fibrin sealant with ropivacaine on pain after laparoscopic cholecystectomy.

World Journal of Gastroenterology : WJG — Fri, 11 Dec 2009 09:32:26 +0100

CONCLUSION: Visceral pain is prominent after LC and can be effectively controlled by implanting fibrin sealant combined with ropivacaine in the gallbladder bed. PMID: 19998508 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)

Laparoscopic retrograde (fundus first) cholecystectomy

BioMed Central — Fri, 11 Dec 2009 00:00:00 +0100

Conclusions: In this series, retrograde laparoscopic dissection was necessary in 1.1% of LCs and a liver retractor was needed in 9 of the 11 cases. This technique does have a place and should be in the armamentarium of the laparoscopic surgeon. (Source: BioMed Central)

Statin use lowers risk of gallstones followed by cholecystectomy

Modern Medicine — Fri, 11 Dec 2009 00:00:00 +0100

Use of statins over a long period of time was associated with a decreased risk of gallstones followed by cholecystectomy. (Source: Modern Medicine)

Trial sequential analyses of meta-analyses of complications in laparoscopic vs. small-incision cholecystectomy: more randomized patients are needed

Journal of Clinical Epidemiology — Fri, 11 Dec 2009 00:00:00 +0100

Conclusions based on meta-analyses of randomized trials carry a status of “truth.” Methodological components may identify trials with systematic errors (“bias”). Trial sequential analysis (TSA) evaluates random errors in meta-analysis. We analyzed meta-analyses on laparoscopic vs. small-incision cholecystectomy regarding different outcome measures for the occurrence of type I errors.Study Design and Setting: Using TSA, we calculated the required information size (IS) and the trial sequential monitoring boundaries regarding complications in our Cochrane review with meta-analyses of cholecystectomy. For each outcome, we calculated a low risk of bias heterogeneity-adjusted IS. As a sensitivity analysis, we calculated an a priori heterogeneity-adjusted IS.Results: According to the tria...

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A novel treatment for bile duct injury with a tissue-engineered bioabsorbable polymer patch

Surgery — Fri, 11 Dec 2009 00:00:00 +0100

Conclusion: The bile duct was dilated only focally at the site of implantation. This newly designed substitute has potential for application as a novel treatment for biliary injury and stenosis. (Source: Surgery)

Pancreatitis bundles

Journal of Hepato-Biliary-Pancreatic Surgery — Thu, 10 Dec 2009 15:18:14 +0100

Abstract Clinical indicators set forth in the guidelines have been found to contribute to the improvement in compliance with the guidelines. On the other hand, it has been shown that clinical indicators are more effective when individual indicators are presented in the form of a bundle than when they are given separately. Accordingly, in the JPN Guidelines 2010 for management of acute pancreatitis, those indicators that are judged to be important on the basis of a recommendation classification of “A or B” are presented as a pancreatitis bundle. Each item includes assessment of severity after a diagnosis of pancreatitis has been made, differentiation of pathogenesis, management of gallstone-induced pancreatitis, a sufficient dose of fluid replacement and monitoring, pai...

Gallstone-induced acute pancreatitis

Journal of Hepato-Biliary-Pancreatic Surgery — Thu, 10 Dec 2009 15:18:12 +0100

Abstract In the care of acute pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Examinations necessary for diagnosing gallstone-induced acute pancreatitis include blood tests and ultrasonography. Early ERCP/ES should be performed in patients with gallstone-induced acute pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. The treatment for bile duct stones with the use of ERCP/ES alone is not recommended in cases of gallstone-induced pancreatitis with gallbladder stones. Cholecystectomy for gallston...

[Endoscopic management of postoperative biliary injuries.]

Orvosi Hetilap — Wed, 09 Dec 2009 00:00:00 +0100

Authors: Völgyi Z, Fischer T, Szenes M, Gasztonyi B The postoperative complications of the biliary tract, such as leakages and strictures, traditionally had been managed surgically, but from the 90s they are usually treated via endoscopic route. These complications occur most frequently after laparoscopic surgeries. Whenever biliary leakage is suspected, close collaboration between endoscopists and surgeons is needed. Immediate visualization of the biliary tract by ERCP is mandatory to confirm the diagnosis and to locate the exact site of the lesion. Various endoscopic techniques have been proved effective in treating post-cholecystectomy biliary leaks. The crucial point is to equalize the duodenal and the biliary pressures, allowing flow of the bile into the duodenum, advancing t...